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a Department of
Gerontology, Catholic University of the Sacred Heart, L go F Vito,
1-00168 Rome, Italy, b Center for Gerontology and
Health Care Research, Brown University, Providence, USA
Correspondence to: Dr G Zuccalà giuseppe_zuccala{at}rm.unicatt.it
Received 9 February
2000 and in revised form 25 July 2000;
Accepted 23 August
2000
Cognitive dysfunction is a frequent finding among older
patients with left ventricular systolic dysfunction; however, the clinical outcomes of such a finding are unknown. Also, disability is a
common condition in heart failure, poorly responding to commonly used
cardiovascular medications. The association between cognitive dysfunction and disability was assessed in 1583 patients with heart
failure, but without cerebrovascular disease, previous stroke, or
Alzheimer's disease, who were enrolled during 2 years of a multicentre
pharmacoepidemiology survey. The association between groups of
variables (demographics, comorbid conditions, medications, and
objective tests, including the Hodkinson abbreviated mental test) and
functional disability (as indicated by need for intensive assistance in
at least one of Katz' activities of daily living) was first analysed
using separate age and sex adjusted logistic regression models. Those
variables, significant at a p<0.1 level in these models, were
simultaneously entered into an age and sex adjusted summary regression
model. Among 1583 patients suitable for analysis, cognitive dysfunction
(as detected by abbreviated mental test score <7) was detected in
265/461 disabled patients, and in 150/1122 independent subjects
(p<0.0001). According to logistic regression analysis, cognitive
dysfunction was associated with disability (OR=6.49; 95%
CI=4.39-9.59) after adjusting for potential confounders.
Thus, cognitive dysfunction in patients with heart failure is
independently associated with disability, which currently represents an
overwhelming medical and financial problem to patients, caregivers, and
public health services. As early recognition and treatment of low
cardiac output states might reverse cognitive dysfunction, cost
effective treatment for heart failure should include systematic diagnostic and therapeutic approaches to cognitive dysfunction.
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